Search results for: pregnancy outcomes

Authors: Lea Stein, Sabine Rösner, Alessandra Lo Giudice, Beate Ditzen, Tewes Wischmann

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For many couples bearing children is a consistent life goal; however, it cannot always be fulfilled. Undergoing infertility treatment does not guarantee pregnancies and live births. Couples have to deal with miscarriages and sometimes even discontinue infertility treatment. Significant medical predictors for the outcome of infertility treatment have yet to be fully identified. To further our understanding, a cross-sectional five-year follow-up survey was undertaken, in which 95 women and 82 men that have been treated at the Women’s Hospital of Heidelberg University participated. Binary logistic regressions, parametric and non-parametric methods were used for our sample to determine the relevance of biological (infertility diagnoses, maternal and paternal age) and lifestyle factors (smoking, drinking, over- and underweight) on the outcome of infertility treatment (clinical pregnancy, live birth, miscarriage, dropout rate). During infertility treatment, 72.6% of couples became pregnant and 69.5% were able to give birth. Suffering from miscarriages 27.5% of couples and 20.5% decided to discontinue an unsuccessful fertility treatment. The binary logistic regression models for clinical pregnancies, live births and dropouts were statistically significant for the maternal age, whereas the paternal age in addition to maternal and paternal BMI, smoking, infertility diagnoses and infections, showed no significant predicting effect on any of the outcome variables. The results confirm an effect of maternal age on infertility treatment, whereas the relevance of other medical predictors remains unclear. Further investigations should be considered to increase our knowledge of medical predictors.

Keywords: advanced maternal age, assisted reproductive technology, female factor, male factor, medical predictors, infertility treatment, reproductive medicine

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Authors: Maryam Borjali

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Introduction. Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. e objective of present study was to identify nonmedical determinants related to this abnormality from the mother’s perspectives. Methods. is research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results. Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions. Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers’ prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.

Keywords: congenital_cou, cultural, social, platform

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Authors: Awadh O. Al-Anazi

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As part of the organizational needs toward successful maintaining activities, a proper management system need to be put in place, ensuring the effectiveness of maintenance activities. The management system shall clearly describes the process of identifying, prioritizing, planning, scheduling, execution, and providing valuable feedback for all maintenance activities. Completion and accuracy of the system with proper implementation shall provide the organization with a strong platform for effective maintenance activities that are resulted in efficient outcomes toward business success. The purpose of this research was to introduce a practical tool for measuring the maintenance efficiency level within Saudi organizations. A comprehensive study was launched across many maintenance professionals throughout Saudi leading organizations. The study covered five main categories: work process, identification, planning and scheduling, execution, and performance monitoring. Each category was evaluated across many dimensions to determine its current effectiveness through a five-level scale from 'process is not there' to 'mature implementation'. Wide participation was received, responses were analyzed, and the study was concluded by highlighting major gaps and improvement opportunities within Saudi organizations. One effective implementation of the efficiency enhancement efforts was deployed in Saudi Kayan (one of Sabic affiliates). Below details describes the project outcomes: SK overall maintenance wrench time was measured at 20% (on average) from the total daily working time. The assessment indicates the appearance of several organizational gaps, such as a high amount of reactive work, poor coordination and teamwork, Unclear roles and responsibilities, as well as underutilization of resources. Multidiscipline team was assigned to design and implement an appropriate work process that is capable to govern the execution process, improve the maintenance workforce efficiency, and maximize wrench time (targeting > 50%). The enhanced work process was introduced through brainstorming and wide benchmarking, incorporated with a proper change management plan and leadership sponsorship. The project was completed in 2018. Achieved Results: SK WT was improved to 50%, which resulted in 1) reducing the Average Notification completion time. 2) reducing maintenance expenses on OT and manpower support (3.6 MSAR Actual Saving from Budget within 6 months).

Keywords: efficiency, enhancement, maintenance, work force, wrench time

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Authors: Hanen Bouaziz, Françoise Croute, Najiba Zeghal

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In order to investigate the toxic effects of fluoride on cerebrum maturity of suckling mice, we treated adult female mice of Swiss Albinos strain by 500 ppm NaF in their drinking water from the 15th day of pregnancy until the day 14 after delivery. All mice were sacrificed on day 14 after parturition. During treatment, levels of thiobarbituric acid reactive substances, the marker of lipid peroxidation extend, increased, while the activities of the antioxidant enzymes such as glutathione peroxidase, superoxide dismutase and catalase and the level of glutathione decreased significantly in cerebellum compared with those of the control group. These results suggested that fluoride enhanced oxidative stress, thereby disturbing the antioxidant defense of nursing pups. In addition, acetylcholinesterase activity in cerebellum was inhibited after treatment with fluoride. In cerebellum of mice, migration of neurons from the external granular layer to the internal granular layer occurred postnatally. Key guidance signals to these migrating neurons were provided by laminin, an extracellular matrix protein fixed to the surface of astrocytes. In the present study, we examined the expression and distribution of laminin in cerebellum of 14-day-old mice. Immunoreactive laminin was disappeared by postnatal day 14 in cerebellum parenchyma of control pups and was restricted to vasculature despite the continued presence of granular cells in the external granular layer. In contrast, in cerebellum of NaF treated pups, laminin was deposited in organised punctuate clusters in the molecular layer. These data indicated that the disruption of laminin distribution might play a major role in the profound derangement of neuronal migration observed in cerebellum of NaF treated pups.

Keywords: acetylcholinesterase activity, cerebellum, laminin, oxidative stress, suckling mice

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Authors: Naseer Ahmad

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This research investigates the intricate dynamics of language policy, ideology, and the choice of educational language as a medium of instruction in rural Pakistan. Focused on addressing the complexities of language practices in underexplored educational contexts, the study employed a case study approach, analyzing interviews with education authorities, teachers, and students, alongside classroom observations in English-medium and Urdu-medium rural schools. The research underscores the significance of understanding linguistic diversity within rural communities. The analysis of interviews and classroom observations revealed that language policies in rural schools are influenced by multiple factors, including historical legacies, societal language ideologies, and government directives. The dominance of Urdu and English as the preferred languages of instruction reflected a broader language hierarchy, where regional languages are often marginalized. This language ideology perpetuates a sense of linguistic inferiority among students who primarily speak regional languages. The impact of language choices on students' learning experiences and outcomes is a central focus of the research. It became evident that while policies advocate for specific language practices, the implementation often diverges due to multifarious socio-cultural, economic, and institutional factors. This disparity significantly impacts the effectiveness of educational processes, influencing pedagogical approaches, student engagement, academic outcomes, social mobility, and language choices. Based on the findings, the study concluded that due to policy and practice gap, rural people have complex perceptions and language choices. They perceived Urdu as a national, lingua franca, cultural, easy, or low-status language. They perceived English as an international, lingua franca, modern, difficult, or high-status language. They perceived other languages as mother tongue, local, religious, or irrelevant languages. This research provided insights that are crucial for theory, policy, and practice, addressing educational inequities and inclusive language policies. It set the stage for further research and advocacy efforts in the realm of language policies in diverse educational settings.

Keywords: language-in-education policy, language ideology, educational language choice, pakistan

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Authors: Genevieve Lim, Arthur Shelley, Dongcheol Heo

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Abstract—Mobile technologies can enhance the learning process as it enables social engagement around concepts beyond the classroom and the curriculum. Early results in this ongoing research is showing that when learning interventions are designed specifically to generate new insights, mobile devices support regulated learning and encourage learners to collaborate, socialize and co-create new knowledge. As students navigate across the space and time boundaries, the fundamental social nature of learning transforms into mobile computer supported collaborative learning (mCSCL). The metacognitive interaction in mCSCL via mobile applications reflects the regulation of learning among the students. These metacognitive experiences whether self-, co- or shared-regulated are significant to the learning outcomes. Despite some insightful empirical studies, there has not yet been significant research that investigates the actual practice and processes of the new knowledge co-creation. This leads to question as to whether mobile learning provides a new channel to leverage learning? Alternatively, does mobile interaction create new types of learning experiences and how do these experiences co-create new knowledge. The purpose of this research is to explore these questions and seek evidence to support one or the other. This paper addresses these questions from the students’ perspective to understand how students interact when constructing knowledge in mCSCL and how students’ self-regulated learning (SRL) strategies support the co-creation of new knowledge in mCSCL. A pilot study has been conducted among international undergraduates to understand students’ perspective of mobile learning and concurrently develops a definition in an appropriate context. Using classroom action research (CAR) with multiple case studies, this study is being carried out in a private university in Thailand to narrow the research gaps in mCSCL and SRL. The findings will allow teachers to see the importance of social interaction for meaningful student engagement and envisage learning outcomes from a knowledge management perspective and what role mobile devices can play in these. The findings will signify important indicators for academics to rethink what is to be learned and how it should be learned. Ultimately, the study will bring new light into the co-creation of new knowledge in a social interactive learning environment and challenges teachers to embrace the 21st century of learning with mobile technologies to deepen and extend learning opportunities.

Keywords: mobile computer supported collaborative learning, mobile instant messaging, mobile learning, new knowledge co-creation, self-regulated learning

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Authors: Md Tareq Ferdous Khan, Shrabanti Mazumder, MB Rao

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Background: Substance use during pregnancy is a longstanding public health problem that results in severe consequences for pregnant women and fetuses. Methods: Eight (2011-2018) datasets on pregnant women’s admissions are extracted from TEDS-A. Distributions of sociodemographic, substance abuse behaviors, and clinical characteristics are constructed and compared over the years for trends by the Cochran-Armitage test. Market basket analysis is used in mining the association among polysubstance abuse. Results: Over the years, pregnant woman admissions as the percentage of total and female admissions remain stable, where total annual admissions range from 1.54 to about 2 million with the female share of 33.30% to 35.61%. Pregnant women aged 21-29, 12 or more years of education, white race, unemployed, holding independent living status are among the most vulnerable. Concerns prevail on a significant number of polysubstance users, young age at first use, frequency of daily users, and records of prior admissions (60%). Trends of abused primary substances show a significant rise in heroin (66%) and methamphetamine (46%) over the years, although the latest year shows a considerable downturn. On the other hand, significant decreasing patterns are evident for alcohol (43%), marijuana or hashish (24%), cocaine or crack (23%), other opiates or synthetics (36%), and benzodiazepines (29%). Basket analysis reveals some patterns of co-occurrence of substances consistent over the years. Conclusions: This comprehensive study can work as a reference to identify the most vulnerable groups based on their characteristics and deal with the most hazardous substances from their evidence of co-occurrence.

Keywords: basket analysis, pregnant women, substance abuse, trend analysis

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Authors: Michelle Nighswander

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Suicide can be a tragic response to mental illness. It is difficult for people to disclose or discuss suicidal impulses. The stigma surrounding mental health can create a reluctance to seek help for mental illness. Patients may feel pressure to exhibit a socially desirable demeanor rather than reveal these issues, especially if they sense their healthcare provider is pressed for time or does not have an extensive history with their provider. Overcoming these barriers can be challenging. Although there are several validated depression and suicide risk instruments, varying processes used to administer these tools may impact the truthfulness of the responses. A literature review was conducted to find evidence of the impact of the environment on the accuracy of depression screening. Many investigations do not describe the environment and fewer studies use a comparison design. However, three studies demonstrated that computerized self-reporting might be more likely to elicit truthful and accurate responses due to increased privacy when responding compared to a face-to-face interview. These studies showed patients reported positive reactions to computerized screening for other stigmatizing health conditions such as alcohol use during pregnancy. Computerized self-screening for depression offers the possibility of more privacy and patient reflection, which could then send a targeted message of risk to the healthcare provider. This could potentially increase the accuracy while also increasing time efficiency for the clinic. Considering the persistent effects of mental health stigma, how these screening questions are posed can impact patients’ responses. This literature review analyzes trends in depression screening methodologies, the impact of setting on the results and how this may assist in overcoming one barrier caused by stigma.

Keywords: computerized self-report, depression, mental health stigma, suicide risk

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Authors: Pravin Mishra, Ajeet K. Jha, Pankaj K. Jha

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This technical note is aimed at providing a brief information on goat breeds, its breeding seasonality and different methods of oestrous synchronization for Nepalese goat farmers. It was observed that, these goats are seasonal breeder and showed oestrous during mainly two season; December- February and March-May. This leads to an irregular supply of goat to market and a wide variations in market price. Oestrus synchronization is only an alternative reproductive tool to overcome this scarcity by enhancing production and productivity. This technique enables goat producers breed their animals within a short pre-determined period and permits breeding round the year. The principle of oestrus synchronisation is based on controlling of the luteal phase of the oestrous cycle. There are two basic mechanisms; one by shortening the luteal life (premature luteolysis) using prostaglandins or its analogues and the other by prolonging the luteal life (simulating the activity of natural progesterone produced by the corpus luteum) using exogenous progesterone source. The former is easy to apply and only effective during breeding season, whereas the latter is advantageous when the reproductive status of the goat flock is unknown. The common hormonal products easily available in Nepal includes; prostaglandins or its analogues (Oviprost® Dinoprost® Lutalyse® and Estrumate®), exogenous progesterone (Fluorogestone acetate® and Controlled Internal Drug Release®, CIDR) devices). However, before practicing the oestrous synchronization protocol, it needs to be validated for oestrous response rate, time to onset of oestrous, duration of oestrous and pregnancy rates at farmer’s field. In conclusion, application of oestrus synchronisation practice enhanced goat production and surplus the goat meat demand in Nepal.

Keywords: goat, Nepal, oestrous, synchronization

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Authors: Joshua Fogel, Rivka Herzog

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Although direct-to-consumer prescription medication advertisements (DTCA) are viewed or heard in many venues, there does not appear to be any research for internet social media DTCA. We study the association of traditional media DTCA and digital media DTCA including internet social media of YouTube, Facebook, and Twitter with three different outcomes. There was one intentions outcome and two different behavior outcomes. The intentions outcome was the agreement level for seeking additional information about a prescription medication after seeing a DTCA. One behavior outcome was the agreement level for obtaining additional information about a prescription medication after seeing a DTCA. The other behavior outcome was the frequency level for obtaining additional information about a prescription medication after seeing a DTCA. Surveys were completed by 635 college students. Predictors included demographic variables, theory of planned behavior variables, health variables, and advertisements seen or heard. Also, in the behavior analyses, additional predictors of intentions and sources for seeking additional prescription drug information were included. Multivariate linear regression analyses were conducted. We found that increased age was associated with increased behavior, women were associated with increased intentions, and Hispanic race/ethnicity was associated with decreased behavior. For the theory of planned behavior variables, increased attitudes were associated with increased intentions, increased social norms were associated with increased intentions and behavior, and increased intentions were associated with increased behavior. Very good perceived health was associated with increased intentions. Advertisements seen in spam mail were associated with decreased intentions. Advertisements seen on traditional or cable television were associated with decreased behavior. Advertisements seen on television watched on the internet were associated with increased behavior. The source of seeking additional information of reading internet print content was associated with increased behavior. No internet social media advertisements were associated with either intentions or behavior. In conclusion, pharmaceutical brand managers and marketers should consider these findings when tailoring their DTCA advertising campaigns and directing their DTCA advertising budget towards young adults such as college students. They need to reconsider the current approach for traditional television DTCA and also consider dedicating a larger advertising budget toward internet television DTCA. Although internet social media is a popular place to advertise, the financial expenditures do not appear worthwhile for DTCA when targeting young adults such as college students.

Keywords: brand managers, direct-to-consumer advertising, internet, social media

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Authors: Yvonne Howard

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This project currently under development is centered around current learning processes, including a thorough literature review and ongoing practical experiences gained as a deputy head in a school. These daily experiences with students engaging in animal-assisted interventions and the school therapy dog form a strong base for this research. The primary objective of this research is to comprehensively explore the impact of dog-assisted well-being interventions on student motivation and affective engagement within primary and secondary school settings. The educational domain currently encounters a significant challenge due to the lack of substantial research in this area. Despite the perceived positive outcomes of such interventions being acknowledged and shared in various settings, the evidence supporting their effectiveness in an educational context remains limited. This study aims to bridge the gap in the research and shed light on the potential benefits of dog-assisted well-being interventions in promoting student motivation and affective engagement. The significance of this topic recognizes that education is not solely confined to academic achievement but encompasses the overall well-being and emotional development of students. Over recent years, there has been a growing interest in animal-assisted interventions, particularly in healthcare settings. This interest has extended to the educational context. While the effectiveness of these interventions in these areas has been explored in other fields, the educational sector lacks comprehensive research in this regard. Through a systematic and thorough research methodology, this study seeks to contribute valuable empirical data to the field, providing evidence to support informed decision-making regarding the implementation of dog-assisted well-being interventions in schools. This research will utilize a mixed-methods design, combining qualitative and quantitative measures to assess the research objectives. The quantitative phase will include surveys and standardized scales to measure student motivation and affective engagement, while the qualitative phase will involve interviews and observations to gain in-depth insights from students, teachers, and other stakeholders. The findings will contribute evidence-based insights, best practices, and practical guidelines for schools seeking to incorporate dog-assisted interventions, ultimately enhancing student well-being and improving educational outcomes.

Keywords: therapy dog, wellbeing, engagement, motivation, AAI, intervention, school

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Authors: Albert Amagyei, Julia Carroll, Amanda R. Amorim Adegboye, Laura Strumidlo, Rosie Kneafsey

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Introduction: Classroom-based learning has persisted as the mainstream model of pre-registration nurse education. This model is often rigid, teacher-centered, and unable to support active learning and the practical learning needs of nursing students. Health Education England (HEE), a public body of the Department of Health and Social Care, hypothesises that blended learning (BL) programmes may address health system and nursing profession challenges, such as nursing shortages and lack of digital expertise, by exploring opportunities for providing predominantly online, remote-access study which may increase nursing student recruitment, offering alternate pathways to nursing other than the traditional classroom route. This study will provide evidence for blended learning strategies adopted in nursing education as well as examine nursing student learning experiences concerning the challenges and opportunities related to using blended learning within nursing education. Objective: This review will explore the challenges and opportunities of BL within pre-registration nurse education from the student's perspective. Methods: The search was completed within five databases. Eligible studies were appraised independently by four reviewers. The JBI-convergent segregated approach for mixed methods review was used to assess and synthesize the data. The study’s protocol has been registered with the International Register of Systematic Reviews with registration number// PROSPERO (CRD42023423532). Results: Twenty-seven (27) studies (21 quantitative and 6 qualitative) were included in the review. The study confirmed that BL positively impacts nursing students' learning outcomes, as demonstrated by the findings of the meta-analysis and meta-synthesis. Conclusion: The review compared BL to traditional learning, simulation, laboratory, and online learning on nursing students’ learning and programme outcomes as well as learning behaviour and experience. The results show that BL could effectively improve nursing students’ knowledge, academic achievement, critical skills, and clinical performance as well as enhance learner satisfaction and programme retention. The review findings outline that students’ background characteristics, BL design, and format significantly impact the success of the BL nursing programme.

Keywords: nursing student, blended learning, pre-registration nurse education, online learning

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Authors: Temesgen Sidamo, Prakruti S. Rao, Eleni Akllilu, Workineh Shibeshi, Yumi Park, Yong-Soon Cho, Jae-Gook Shin, Scott K. Heysell, Stellah G. Mpagama, Ephrem Engidawork

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The fluoroquinolones (FQs) are used off-label for the treatment of multidrug-resistant tuberculosis (MDR-TB), and for evaluation in shortening the duration of drug-susceptible TB in recently prioritized regimens. Within the class, levofloxacin (LFX) and moxifloxacin (MXF) play a substantial role in ensuring success in treatment outcomes. However, sub-therapeutic plasma concentrations of either LFX or MXF may drive unfavorable treatment outcomes. To the best of our knowledge, the pharmacokinetics of LFX and MXF in Ethiopian patients with MDR-TB have not yet been investigated. Therefore, the aim of this study was to develop a population pharmacokinetic (PopPK) model of levofloxacin (LFX) and moxifloxacin (MXF) and assess the percent probability of target attainment (PTA) as defined by the ratio of the area under the plasma concentration-time curve over 24-h (AUC0-24) and the in vitro minimum inhibitory concentration (MIC) (AUC0-24/MIC) in Ethiopian MDR-TB patients. Steady-state plasma was collected from 39 MDR-TB patients enrolled in the programmatic treatment course and the drug concentrations were determined using optimized liquid chromatography-tandem mass spectrometry. In addition, the in vitro MIC of the patients' pretreatment clinical isolates was determined. PopPK and simulations were run at various doses, and PK parameters were estimated. The effect of covariates on the PK parameters and the PTA for maximum mycobacterial kill and resistance prevention was also investigated. LFX and MXF both fit in a one-compartment model with adjustments. The apparent volume of distribution (V) and clearance (CL) of LFX were influenced by serum creatinine (Scr), whereas the absorption constant (Ka) and V of MXF were influenced by Scr and BMI, respectively. The PTA for LFX maximal mycobacterial kill at the critical MIC of 0.5 mg/L was 29%, 62%, and 95% with the simulated 750 mg, 1000 mg, and 1500 mg doses, respectively, whereas the PTA for resistance prevention at 1500 mg was only 4.8%, with none of the lower doses achieving this target. At the critical MIC of 0.25 mg/L, there was no difference in the PTA (94.4%) for maximum bacterial kill among the simulated doses of MXF (600 mg, 800 mg, and 1000 mg), but the PTA for resistance prevention improved proportionately with dose. Standard LFX and MXF doses may not provide adequate drug exposure. LFX PopPK is more predictable for maximum mycobacterial kill, whereas MXF's resistance prevention target increases with dose. Scr and BMI are likely to be important covariates in dose optimization or therapeutic drug monitoring (TDM) studies in Ethiopian patients.

Keywords: population PK, PTA, moxifloxacin, levofloxacin, MDR-TB patients, ethiopia

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Authors: Bruna Azzari Puga, Richard Roe, Andre Pagani de Souza

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abstract outlines a proposed study to examine how and to what extent interactive, experiential, learner centered methodology develops learning of basic civic and democratic competencies among young children. It stems from the Literacy and Law course taught at Georgetown University Law Center in Washington, DC, since 1998. Law students, trained in best literacy practices and legal cases affecting literacy development, read “law related” children’s books and engage in interactive and extension activities with emerging readers. The law students write a monthly journal describing their experiences and a final paper: a conventional paper or a children’s book illuminating some aspect of literacy and law. This proposal is based on the recent adaptation of Literacy and Law to Brazil at Mackenzie Presbyterian University in São Paulo in three forms: first, a course similar to the US model, often conducted jointly online with Brazilian and US law students; second, a similar course that combines readings of children’s literature with activity based learning, with law students from a satellite Mackenzie campus, for young children from a vulnerable community near the city; and third, a course taught by law students at the main Mackenzie campus for 4th grade students at the Mackenzie elementary school, that is wholly activity and discourse based. The workings and outcomes of these courses are well documented by photographs, reports, lesson plans, and law student journals. The authors, faculty who teach the above courses at Mackenzie and Georgetown, observe that literacy, broadly defined as cognitive and expressive development through reading and discourse-based activities, can be influential in developing democratic civic skills, identifiable by explicit civic competencies. For example, children experience justice in the classroom through cooperation, creativity, diversity, fairness, systemic thinking, and appreciation for rules and their purposes. Moreover, the learning of civic skills as well as the literacy skills is enhanced through interactive, learner centered practices in which the learners experience literacy and civic development. This study will develop rubrics for individual and classroom teaching and supervision by examining 1) the children’s books and students diaries of participating law students and 2) the collection of photos and videos of classroom activities, and 3) faculty and supervisor observations and reports. These rubrics, and the lesson plans and activities which are employed to advance the higher levels of performance outcomes, will be useful in training and supervision and in further replication and promotion of this form of teaching and learning. Examples of outcomes include helping, cooperating and participating; appreciation of viewpoint diversity; knowledge and utilization of democratic processes, including due process, advocacy, individual and shared decision making, consensus building, and voting; establishing and valuing appropriate rules and a reasoned approach to conflict resolution. In conclusion, further development and replication of the learner centered literacy and law practices outlined here can lead to improved qualities of democratic teaching and learning supporting mutual respect, positivity, deep learning, and the common good – foundation qualities of a sustainable world.

Keywords: democracy, law, learner-centered, literacy

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Authors: Elin Mordal, Meseret Tsegaye, Hirut Gemeda, Ingeborg Ulvund

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Background: Even the rural-urban gap in the provision of skilled care during childbirth has narrowed, developing countries have the highest percentage of maternal deaths. More important than uncovering deficiencies during pregnancy, is preventing situations of risk during childbirth. The aim of this study was to identify factors women in the rural area consider before they decide where to give birth. Methods: This study utilizes a qualitative descriptive design based on individual interviews with 25 women of childbearing age who has given birth at least once, where women who delivered both at home and a health centre were included. Data collection took place in rural areas around Hawassa Zuriya Worda in Ethiopia February 2015. To identify conditions associated to where women prefer to give birth a thematic analysis was carried out. Result: Experienced risks regarding child birth were the most common reason for women and their families to seek help from skilled birth attendants. Decision-making and planning were identified as a major factor contributing to where women give birth. The women’s position and responsibilities pointed to the fact that women's role is mainly to take care of children and manage the household, while husbands, mother in laws and the elderly are the family members who take most of the decisions. This includes decision about where women give birth. The infrastructure also influences where women choose to give birth. Conclusion: To further improve childbirth care in Hawassa Zuriya Worda it’s important that women get positive experiences, and are met in a safe and supportive way at Health Centers. Challenges appear to women’s autonomy, quality aspects, and infrastructure.

Keywords: childbirth, women, health care utilization, Hawassa Zuriya Worda, Ethiopia, rural area

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Authors: S. Jigna, K. Nanda Kumar, T. Anna

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Being a major contributor to the Indian economy and a critical facilitator for the country’s digital India vision, the Indian telecommunications industry is also a major source of employment for the country. Since the last few years, the Indian telecommunication service providers (TSPs), however, are facing business challenges related to increasing competition, losses, debts, and decreasing revenue. The strategic use of digital technologies for a successful digital transformation has the potential to equip organizations to meet these business challenges. Despite an increased focus on digital transformation, the telecom service providers globally, including Indian TSPs, have seen limited success so far. The purpose of this research was thus to identify the factors that are critical for the digital transformation and to what extent they influence the successful digital transformation of the Indian TSPs. The literature review of more than 300 digital transformation-related articles, mostly from 2013-2019, demonstrated a lack of an empirical model consisting of factors for the successful digital transformation of the TSPs. This study theorizes a research framework grounded in multiple theories, and a research model consisting of 7 constructs that may be influencing business success during the digital transformation of the organization was proposed. The questionnaire survey of senior managers in the Indian telecommunications industry was seeking to validate the research model. Based on 294 survey responses, the validation of the Structural equation model using the statistical tool ADANCO 2.1.1 was found to be robust. Results indicate that Digital Capabilities, Digital Strategy, and Corporate Level Data Strategy in that order has a strong influence on the successful Business Performance, followed by IT Function Transformation, Digital Innovation, and Transformation Management respectively. Even though Digital Organization did not have a direct significance on Business Performance outcomes, it had a strong influence on IT Function Transformation, thus affecting the Business Performance outcomes indirectly. Amongst numerous practical and theoretical contributions of the study, the main contribution for the Indian TSPs is a validated reference for prioritizing the transformation initiatives in their strategic roadmap. Also, the main contribution to the theory is the possibility to use the research framework artifact of the present research for quantitative validation in different industries and geographies.

Keywords: corporate level data strategy, digital capabilities, digital innovation, digital strategy

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Authors: Muhammad Saleem

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Background: The teaching of sports sciences encompasses a broad spectrum of disciplines, including biomechanics, physiology, psychology, and coaching. Effective pedagogical techniques are crucial in imparting both theoretical knowledge and practical skills necessary for students to excel in the field. The impact of these techniques on students’ learning outcomes, engagement, and professional preparedness remains a vital area of study. Objective: This study aims to evaluate the effectiveness of various pedagogical techniques used in the teaching of sports sciences. It seeks to identify which methods most significantly enhance student learning, retention, engagement, and practical application of knowledge. Methods: A mixed-methods approach was employed, including both quantitative and qualitative analyses. The study involved a comparative analysis of traditional lecture-based teaching, experiential learning, problem-based learning (PBL), and technology-enhanced learning (TEL). Data were collected through surveys, interviews, and academic performance assessments from students enrolled in sports sciences programs at multiple universities. Statistical analysis was used to evaluate academic performance, while thematic analysis was applied to qualitative data to capture student experiences and perceptions. Results: The findings indicate that experiential learning and PBL significantly improve students' understanding and retention of complex sports science concepts compared to traditional lectures. TEL was found to enhance engagement and provide students with flexible learning opportunities, but its impact on deep learning varied depending on the quality of the digital resources. Overall, a combination of experiential learning, PBL, and TEL was identified as the most effective pedagogical approach, leading to higher student satisfaction and better preparedness for real-world applications. Conclusion: The study underscores the importance of adopting diverse and student-centered pedagogical techniques in the teaching of sports sciences. While traditional lectures remain useful for foundational knowledge, integrating experiential learning, PBL, and TEL can substantially improve student outcomes. These findings suggest that educators should consider a blended approach to pedagogy to maximize the effectiveness of sports science education.

Keywords: sport sciences, pedagogical techniques, health and physical education, problem-based learning, student engagement

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Authors: Darawan Augsornwan, Artitaya Sabangbal, Maneewan Srijan, Kanokarn Kongpitee, Lalida Petphai, Palakorn Surakunprapha

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Background: Srinagarind Hospital, Ward 3C, has patients with head and neck cancer, congenital urology anomalies such as hypospadis, cleft lip and cleft palate and congenital megacolon who need surgery. Undergoing surgery is a difficult time for patients/ family; they feel fear and anxiety. Nurses work closely with patients and family for 24 hours in the process of patients care, so should have the good nursing ability, innovation and an efficient nursing care system to promote patients self-care ability reducing suffering and preventing complications. From previous nursing outcomes we found patients did not receive appropriate information, could not take care of their wound, not early ambulation after the operation and lost follow-up. Objective: to develop the nursing system for patients who were undergoing an operation. Method: this is a participation action research. The sample population was 11 nurses and 60 patients. This study was divided into 3 phase: Phase 1. Situation review In this phase we review the clinical outcomes, the process of care from documents such as nurses note and interview nurses, patients and family about the process of care by nurses. Phase 2: focus group with 11 nurses, searching guideline for specific care, nursing care system then establish the protocol. This phase we have the protocol for giving information, teaching protocol and teaching record, leaflet for all of top five diseases, make video media to convey information, ambulation package and protocol for patients with head and neck cancer, patients zoning, primary nurse, improved job description for each staff level. Program to record number of patients, kind of medical procedures for showing nurses activity each day. Phase 3 implementation and evaluation. Result: patients/family receive appropriate information about deep breathing exercise, cough, early ambulation after the operation, information during the stay in the hospital. Patients family satisfaction is 95.04 percent, appropriate job description for a practical nurse, nurse aid, and worker. Nurses satisfaction is 95 percent. The complications can be prevented. Conclusion: the nursing system is the dynamic process using evidence to develop nursing care. The appropriate system depends on context and needs to keep an eye on every event.

Keywords: development, nursing system, patients undergoing operation, 3C Ward

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Authors: Samantha R. Dutra

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There are many issues that students face in college, such as academic-based struggles, financial issues, family responsibilities, and vocational problems. Students with dyslexia struggle even more with these problems compared to other students. This qualitative study examines faculty perceptions of instructing students with dyslexia. This study is important to the human services and post-secondary educational fields due to the increase in disabled students enrolled in college. This study is also substantial because of the reported bias faced by students with dyslexia and their academic failure. When students with LDs such as dyslexia experience bias, discrimination, and isolation, they are more apt to not seek accommodations, lack communication with faculty, and are more likely to drop out or fail. College students with dyslexia often take longer to complete their post-secondary education and are more likely to withdraw or drop out without earning a degree. Faculty attitudes and academic cultures are major barriers to the success and use of accommodations as well as modified instruction for students with disabilities, which leads to student success. Faculty members are often uneducated or misinformed regarding students with dyslexia. More importantly, many faculty members are unaware of the many ethical and legal implications that they face regarding accommodating students with dyslexia. Instructor expectations can generally be defined as the understanding and perceptions of students regarding their academic success. Skewed instructor expectations can affect how instructors interact with their students and can also affect student success. This is true for students with dyslexia in that instructors may have lower and biased expectations of these students and, therefore, directly impact students’ academic successes and failures. It is vital to understand how instructor attitudes affect the academic achievement of dyslexic students. This study will examine faculty perceptions of instructing students with dyslexia and faculty attitudes towards accommodations and institutional support. The literature concludes that students with dyslexia have many deficits and several learning needs. Furthermore, these are the students with the highest dropout and failure rates, as well as the lowest retention rates. Disabled students generally have many reasons why accommodations and supports just do not help. Some research suggests that accommodations do help students and show positive outcomes. Many improvements need to be made between student support service personnel, faculty, and administrators regarding providing access and adequate supports for students with dyslexia. As the research also suggests, providing more efficient and effective accommodations may increase positive student as well as faculty attitudes in college, and may improve student outcomes overall.

Keywords: dyslexia, faculty perception, higher education, learning disability

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Authors: Cem Çindaş, Serkan Şimşek

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In this paper, the study and design of a 3-dB 90° directional coupler operating in the S-band is proposed. The coupler employs symmetrical multi-section coupled lines designed in a stripline technique. Design is realized in AWR Design Environment and CST Microwave Studio. Using these two programs played a key role in attaining outcomes swiftly and precisely. The simulation results show that the coupler maintains amplitude consistency within ± 0.3 dB, isolation and reflection losses better than 16 dB, and phase difference between two output ports of 88º±0.6˚ in the 1.7 – 4.35 GHz range. This simulation results indicate an improvement is achieved in fractional bandwidth (FBW) performance around the center frequency of f0 = 3 GHz.

Keywords: coupled stripline, directional coupler, multi-section coupler, symmetrical coupler

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Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado

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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.

Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses

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Authors: Jillian M. Hagel, Joseph E. Tucker, Peter J. Facchini

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With the aim of establishing a holistic approach for the treatment of central nervous system (CNS) disorders, we are pursuing a drug development program rapidly progressing through discovery and characterization phases. The drug candidates identified in this program are referred to as neuroplastogens owing to their ability to mediate neuroplasticity, which can be beneficial to patients suffering from anxiety, depression, or posttraumatic stress disorder. These and other related neuropsychiatric conditions are associated with the onset of neuronal atrophy, which is defined as a reduction in the number and/or productivity of neurons. The stimulation of neuroplasticity results in an increase in the connectivity between neurons and promotes the restoration of healthy brain function. We have synthesized a substantial catalogue of proprietary indolethylamine derivatives based on the general structures of serotonin (5-hydroxytryptamine) and psychedelic molecules such as N,N-dimethyltryptamine (DMT) and psilocin (4-hydroxy-DMT) that function as neuroplastogens. A primary objective in our screening protocol is the identification of derivatives associated with a significant reduction in hallucination, which will allow administration of the drug at a dose that induces neuroplasticity and triggers other efficacious outcomes in the treatment of targeted CNS disorders but which does not cause a psychedelic response in the patient. Both neuroplasticity and hallucination are associated with engagement of the 5HT2A receptor, requiring drug candidates differentially coupled to these two outcomes at a molecular level. We use novel and proprietary artificial intelligence algorithms to predict the mode of binding to the 5HT2A receptor, which has been shown to correlate with the hallucinogenic response. Hallucination is tested using the mouse head-twitch response model, whereas mouse marble-burying and sucrose preference assays are used to evaluate anxiolytic and anti-depressive potential. Neuroplasticity is assays using dendritic outgrowth assays and cell-based ELISA analysis. Pharmacokinetics and additional receptor-binding analyses also contribute the selection of lead candidates. A summary of the program is presented.

Keywords: neuroplastogen, non-hallucinogenic, drug development, anxiety, depression, PTSD, indolethylamine derivatives, psychedelic-inspired, 5-HT2A receptor, computational chemistry, head-twitch response behavioural model, neurite outgrowth assay

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the country. The elevated death and disease among ex-slaves were attributable to the unavailability of healthcare. To address the paucity of healthcare services, the College, an institution with the mission of educating minority professionals and serving the under served population, was established in 1876. This study was designed to assess if the College has accomplished its mission of serving under served communities and contributed to the elimination of health disparities in the United States. The study objective was to quantify the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities, which, in turn, was significantly associated with a health professional shortage score partly designated by the U.S. Department of Health and Human Services. Various statistical methods were used to analyze the alumni data in years 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates into the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t test was performed to detect the significant mean differences for clustering and criterion variables between Disadvantaged and Non-disadvantaged Communities, which confirms the “content” validity of cluster analysis model. Chi-square test was used to assess if the proportion of cluster groups (Disadvantaged vs Non-disadvantaged Communities) were consistent with that of practicing specialties (primary care vs. non-primary care). Finally, the partial least squares (PLS) path model was constructed to explore the “construct” validity of analytics model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving disadvantaged community. The social ecological theory along with statistical models mentioned was used to establish the relationship between medical and dental graduates (primary care professionals serving disadvantaged communities) and their social environments (socioeconomic status, adverse health outcome, health professional shortage score). Based on social ecological framework, it was hypothesized that the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities could be quantified. Also, primary care professionals serving disadvantaged communities related to a health professional shortage score can be measured. Adverse health outcome (adult obesity rate, age-adjusted premature mortality rate, and percent of people diagnosed with diabetes) could be affected by the latent variable, namely socioeconomic status (unemployment rate, poverty rate, percent of children who were in free lunch programs, and percent of uninsured adults). The study results indicated that approximately 83% (3,192/3,864) of the College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. In addition, the PLS path modeling demonstrated that primary care professionals serving disadvantaged community was significantly associated with socioeconomic status and adverse health outcome (p < .001). In summary, the majority of medical and dental graduates from the College provide primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcomes, which demonstrate that the College has fulfilled its mission.

Keywords: disadvantaged community, K-means cluster analysis, PLS path modeling, primary care

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Authors: Jocelyne Kenne Kenne

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Previous works in the field of sociolinguistics have explored the various outcomes of linguistic pluralism. One of these outcomes is the creation of new languages. The presentation will focus on one of such languages, Camfranglais, a hybrid language spoken by Cameroonians. It appeared in the 1970s in the francophone area in Cameroon and developed as a result of interactions between French, English, Cameroonian Pidgin English and local Cameroonian languages, all languages spoken in Cameroon. With the migration of Cameroonians to Europe, researches have been conducted to analyze the sociolinguistic profile of Cameroonians in their new environment. The emphasis on this presentation will be on two recent studies that have been conducted to analyze the peculiarity of Camfranglais in two European countries: Germany and Italy. The research involved 59 Cameroonians living in Italy and 49 Cameroonians residing in Germany. The respondents were composed of participants from different linguistic background, students and workers, married and single. A combination of quantitative and qualitative research methods was employed. The field study was divided into three parts. The first part was focused on observing the Cameroonians interact in different places such as in canteens, in the university halls of residence, lecture theatres, at homes, at various Cameroonian meetings. Those observations were accompanied by audio-recordings of the various interactions. The aim was to study communication between Cameroonians to see whether they use Camfranglais or not; if yes, in which domains and what were the speakers’ linguistic profiles. Additionally, questionnaires of different lengths were used to collect biographical information concerning the participants and their sociolinguistic profile and finally, in-depth interviews with Cameroonians were conducted to inquire about the use, the functions and the importance of this language in the migratory context. The results of the research demonstrate how a widespread use of Camfranglais by Cameroonians in Germany and Italy reveal a longing for home on the one hand and a sign of belonging on the other. It also shows the differences that exist between the profiles of Camfranglais speakers in Europe and the speakers in Cameroon notably in terms of age and social class. Finally, it points out some differences in the use, the structure and the functions of this hybrid language in the migratory setting. This study is a contribution to existing research in the field of contact languages and can serve as a comparison for other situations of multilingualism and the creation of mixed languages. Furthermore, with globalization, the study of migrant languages and the contact of these languages with new languages are topics that might be productive for further research in the field of sociolinguistics.

Keywords: interaction, migrants language, multilingualism, mixed languages

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Authors: Sandra Ghavam Shirazi, Komeil Valipourian, Mohammad Reza Golhashem

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This paper represents the basic idea and mechanisms associated with the durability of geomembranes and discusses the factors influencing the service life and temperature of geomembrane liners. Geomembrane durability is stated as field performance and laboratory test outcomes under various conditions. Due to the high demand of geomembranes as landfill barriers and their crucial role in sensitive projects, sufficient service life of geomembranes is very important, therefore in this paper, the durability, the effect of temperature on geomembrane and the role of this type of reinforcement in different types of soil will be discussed. Also, the role of geomembrane in the earthquake will be considered in the last part of the paper.

Keywords: geomembrane, durability temperature soil mechanic, soil

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Authors: Carolinda Douglass

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Institutional Effectiveness (IE) is the purposeful integration of functions that foster student success and support institutional performance. IE is growing rapidly within higher education as it is increasingly viewed by higher education administrators as a beneficial approach for promoting data-informed decision-making in campus-wide strategic planning and execution of strategic initiatives. Specific IE tools, including, but not limited to, project management; impactful collaboration and communication; commitment to continuous quality improvement; and accountability through rigorous evaluation; are gaining momentum under the auspices of IE. This research utilizes a case study approach to examine the use of these IE tools, highlight successes of this use, and identify areas for improvement in the implementation of IE tools within higher education. The research includes three case studies: (1) improving upon academic program review processes including the assessment of student learning outcomes as a core component of program quality; (2) revising an institutional vision, mission, and core values; and (3) successfully navigating an institution-wide re-accreditation process. Several methods of data collection are embedded within the case studies, including surveys, focus groups, interviews, and document analyses. Subjects of these methods include higher education administrators, faculty, and staff. Key findings from the research include areas of success and areas for improvement in the use of IE tools associated with specific case studies as well as aggregated results across case studies. For example, the use of case management proved useful in all of the case studies, while rigorous evaluation did not uniformly provide the value-added that was expected by higher education decision-makers. The use of multiple IE tools was shown to be consistently useful in decision-making when applied with appropriate awareness of and sensitivity to core institutional culture (for example, institutional mission, local environments and communities, disciplinary distinctions, and labor relations). As IE gains a stronger foothold in higher education, leaders in higher education can make judicious use of IE tools to promote better decision-making and secure improved outcomes of strategic planning and the execution of strategic initiatives.

Keywords: accreditation, data-informed decision-making, higher education management, institutional effectiveness tools, institutional mission, program review, strategic planning

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Authors: Rowanda Daoud Ahmed, Mansoor Abdulhak, Muhammad Azeem Afzal, Sezer Filiz, Usama Ahmad Mughal

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This paper discusses important aspects of AI in the healthcare domain. The increase of data in healthcare both in size and complexity, opens more room for artificial intelligence applications. Our focus is to review the main AI methods within the scope of the health care domain. The results of the review show that recommendations for diagnosis and recommendations for treatment, patent engagement, and administrative tasks are the key applications of AI in healthcare. Understanding the potential of AI methods in the domain of healthcare would benefit healthcare practitioners and will improve patient outcomes.

Keywords: AI in healthcare, technologies of AI, neural network, future of AI in healthcare

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Authors: Aryati Yashadhana, Ted Fields Jnr., Wendy Fernando, Kelvin Brown, Godfrey Blitner, Francis Hayes, Ruby Stanley, Brian Donnelly, Bridgette Jerrard, Anthea Burnett, Anthony B. Zwi

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Indigenous Australians experience some of the worst health outcomes globally, with life expectancy being significantly poorer than those of non-Indigenous Australians. This is largely attributed to preventable diseases such as diabetes (prevalence 39% in Indigenous Australian adults > 55 years), which is attributed to a raised risk of diabetic visual impairment and cataract among Indigenous adults. Our study aims to explore the interface between structural and sociocultural determinants and human agency, in order to understand how they impact (1) accessibility of eye health and chronic disease services and (2) the potential for Indigenous patients to achieve positive clinical eye health outcomes. We used Participatory Action Research methods, and aimed to privilege the voices of Indigenous people through community collaboration. Semi-structured interviews (n=82) and patient focus groups (n=8) were conducted by Indigenous Community-Based Researchers (CBRs) with diabetic Indigenous adults (> 40 years) in four remote communities in Australia. Interviews (n=25) and focus groups (n=4) with primary health care clinicians in each community were also conducted. Data were audio recorded, transcribed verbatim, and analysed thematically using grounded theory, comparative analysis and Nvivo 10. Preliminary analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural and contextual appropriateness to interpreting responses, knowledge exchange and capacity building. Identified themes were conceptualised into three spheres of influence: structural (health services, government), sociocultural (Indigenous cultural values, distrust of the health system, ongoing effects of colonialism and dispossession) and individual (health beliefs/perceptions, patient phenomenology). Permeating these spheres of influence were three core determinants: economic disadvantage, health literacy/education, and cultural marginalisation. These core determinants affected accessibility of services, and the potential for patients to achieve positive clinical outcomes at every level of care (primary, secondary, tertiary). Our findings highlight the clinical realities of institutionalised and structural inequities, illustrated through the lived experiences of Indigenous patients and primary care clinicians in the four sampled communities. The complex determinants surrounding inequity in health for Indigenous Australians, are entrenched through a longstanding experience of cultural discrimination and ostracism. Secure and long term funding of Aboriginal Community Controlled Health Services will be valuable, but are insufficient to address issues of inequity. Rather, working collaboratively with communities to build trust, and identify needs and solutions at the grassroots level, while leveraging community voices to drive change at the systemic/policy level are recommended.

Keywords: indigenous, Australia, culture, public health, eye health, diabetes, social determinants of health, sociology, anthropology, health equity, aboriginal and Torres strait islander, primary care

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Authors: Hammad Khalid

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In this paper, a strategy for computerized arranging of Fiber to the Home (FTTH) get to systems is proposed. We presented an efficient methodology for arranging access organize framework. The GIS information and a lot of calculations were utilized to make the arranging procedure increasingly programmed. The technique clarifies various strides of the arranging process. Considering various situations, various designs can be produced by utilizing the technique. It was likewise conceivable to produce the designs in an extremely brief temporal contrast with the conventional arranging. A contextual investigation is considered to delineate the utilization and abilities of the arranging technique. The technique, be that as it may, doesn't completely robotize the arranging however, make the arranging procedure fundamentally quick. The outcomes and dialog are displayed and end is given at last.

Keywords: FTTH, GIS, robotize, plan

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Authors: Petr Daniel Edward Kovarik, Malcolm Jackson, Charles Kelly, Rahul Patil, Shahid Iqbal

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Introduction: Recognition of the presence of extra capsular spread (ECS) has been a major change in the TNM 8th edition published by the American Joint Committee on Cancer in 2018. Irrespective of the size or number of lymph nodes, the presence of ECS makes N3b disease a stage IV disease. The objective of this retrospective observational study was to conduct a comparative analysis of survival outcomes in patients with lymph node-positive cutaneous head and neck squamous cell carcinoma (CHNSCC) based on their TNM 7th and TNM 8th editions classification. Materials and Methods: From January 2010 to December 2020, 71 patients with CHNSCC were identified from our centre’s database who were treated with radical surgery and adjuvant radiotherapy. All histopathological reports were reviewed, and comprehensive nodal mapping was performed. The data were collected retrospectively and survival outcomes were compared using TNM 7th and 8th editions. Results: The median age of the whole group of 71 patients was 78 years, range 54 – 94 years, 63 were male and 8 female. In total, 2246 lymph nodes were analysed; 195 were positive for cancer. ECS was present in 130 lymph nodes, which led to a change in TNM staging. The details on N-stage as per TNM 7th edition was as follows; pN1 = 23, pN2a = 14, pN2b = 32, pN2c = 0, pN3 = 2. After incorporating the TNM 8th edition criterion (presence of ECS), the details on N-stage were as follows; pN1 = 6, pN2a = 5, pN2b = 3, pN2c = 0, pN3a = 0, pN3b = 57. This showed an increase in overall stage. According to TNM 7th edition, there were 23 patients were with stage III and remaining 48 patients, stage IV. As per TNM 8th edition, there were only 6 patients with stage III as compared to 65 patients with stage IV. For all patients, 2-year disease specific survival (DSS) and overall survival (OS) were 70% and 46%. 5-year DSS and OS rates were 66% and 20% respectively. Comparing the survival between stage III and stage IV of the two cohorts using both TNM 7th and 8th editions, there is an obvious greater survival difference between the stages if TNM 8th staging is used. However, meaningful statistics were not possible as the majority of patients (n = 65) were with stage IV and only 6 patients were stage III in the TNM 8th cohort. Conclusion: Our study provides a comprehensive analysis on lymph node data mapping in this specific patient population. It shows a better differentiation between stage III and stage IV in the TNM 8th edition as compared to TNM 7th however meaningful statistics were not possible due to the imbalance of patients in the sub-cohorts of the groups.

Keywords: cutaneous head and neck squamous cell carcinoma, extra capsular spread, neck lymphadenopathy, TNM 7th and 8th editions

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